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17 Questions to Answer Before Working with Consumers Online as a Licensed Mental Health Professional

What might a consumer want to know when hiring you to work as a “licensed” professional? These 17 questions were sparked by an interview with a journalist who asked me what a consumer might need to consider when hiring a Licensed Mental Health Professional online. The questions then, are meant to help both professionals and consumers think about the issues their online therapists should address, at least when asked, if not before delivering professional care.

Licensed Mental Health ProfessionalThe questions were sparked by an interview with a journalist who asked me what a consumer might need to consider when hiring a professional online.  Granted, it is inconceivable that any one client or patient would ask all of these highly specific questions, or that we need to address them all for each patient. However, most of us would agree, that if asked any of these questions in our in-person sessions, we’d be able to answer them. Therefore, my position is that we should be able to answer them online if we propose to offer professional services online.

Again, clients might ask any one or even several questions. Some clients might ask even more specific questions.  These questions then, are meant to help both professionals and consumers think about the issues:

  1. Do I ask for proof that someone has  specialized training to work with people online? How do I even know if they are licensed or trained?
  2. Are they telling me everything I’m supposed to know regarding confidentiality? For example, aren’t they supposed to report me if I did or am planning to kill myself or someone else? What if I want to tell them I’m hurting a child or elderly person?
  3. What happens if we start talking and I get upset, then the connection dies? Do they call my house or just forget about me? What if I don’t want them to call me back in that moment because I’m too mad and I don’t know how to calm myself down? What’s a reasonable plan?
  4. What will happen if the counselor decides at any point that I am not of legal age or of sound enough mind to continue the online counseling? Do I just get dumped?
  5. What will they write in my medical record and where does that file go? Will my orthopedist or GP see it?  Do I get the chance to see or correct my file? Who else sees that file? Administrative staff?  What other things am I supposed to know ahead of time?
  6. What should I do if I feel like I need to contact them and they aren’t available,  or never show up again? What if they die? Will someone else contact me?
  7. Is it ok for my counselor or therapist to give me their personal email address? What if I see their Facebook page and send them a message there? Are they supposed to answer or ignore me? What if I see all their family discussions and home pictures? Is that really ok? What if I get upset by something I see them post to another patient on their Twitter account? What if they send me an email meant for another patient? Should I tell them? Are they accidentally sending my emails to other patients, too?
  8. Who legitimately gets to see my information? Staff? Programmers? Google mail? What should I do if I suddenly get put on spam lists or get contacted by someone else  for other offers? What is HIPAA and how does that apply to me online?
  9. What happens if my spouse/child/parent/friend intercepts an email addressed to me from my doctor? How much personal information will be in that email?
  10. If I sue the counselor, how much of the private information I gave them during my email conversation is going to get revealed to the public court, and then made available on my county website by my court?
  11. What are my rights if I am involved in a court proceeding and want to have my record used  to support a child custody claim, for instance?
  12. What will happen if the chat room, email or Skype system I use to communicate gets hacked; or if the file about my account gets tampered? Will they know? Will they tell me?
  13. If my record is shared with other parties, such as law enforcement, the court, or other governmental agencies, am I going to be informed? If yes, when? Before or after? If after, how long after?
  14. How does an online therapist know where to send me in my local community if I am really upset? Will they take the easy way out and just tell me to “go to the emergency room” or “use the Internet to find someone locally”? Is that right?
  15. I come from another country and speak a different first language. What if they don’t really understand me? Should I pay to have them learn more about my world if they bill me by the minute or hour? Do they have any responsibility to know about my race,  sexual orientation, culture or religion before agreeing to work with me?
  16. Where should I complain if I have a problem with someone I hired online? Do I file a claim with their state licensing board, as I would offline? Will their state follow up if I don’t live in their state?
  17. Should a therapist have the answers to these questions available to me if I ask? Should they tell me without my asking? Isn’t this process called “informed consent?” Or am I just being paranoid?

Also of relevance is what your licensing board and professional association would say about how you need to proceed with such issues.  As a clinician (the intended audience for this website), would you add or delete any questions? Your input would be appreciated.

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